Diabetes and its complications are becoming a major burden in sub-Saharan Africa, and prevalence is set to double by 2030. With the fastest rate of urbanisation worldwide and major changes in lifestyle, the region is already facing an epidemic of type 2 diabetes with few resources. African governments urgently need to implement national diabetes prevention programmes to address this public health and socioeconomic time bomb. Tackling diabetes in Africa will require a multidisciplinary and coordinated effort involving the health, financial, education, sports, and agricultural sectors, concludes a Seminar published in this week's American Diabetes Association meeting special issue of The Lancet.
Jean Claude Mbanya from the University of Yaoundé, Cameroon, and colleagues say that while public health in sub-Saharan Africa has historically prioritised communicable diseases such as HIV/AIDS, non-communicable diseases including diabetes have become major causes of morbidity and mortality.
Diabetes presents a huge and growing cost in terms of medical care and loss of human resources. In the 34 poorest African countries, the total direct and indirect cost of diabetes per person with the disease is estimated to be more than double the gross national income per head. A recent study estimated the direct cost of diabetes care per patient at about 25% of gross national income per head for the 12 richest African countries, and almost 125% of gross national income per head for the 34 poorest countries.
The authors discuss how the epidemic has been fuelled by rapid urbanisation, and by people being less active and eating fattier diets. They say that in a country where obesity is still viewed as a sign of good living and wealth, any efforts to tackle lifestyle risk factors for diabetes will first have to address traditional perceptions and ensure that socioculturally appropriate diabetes programmes are implemented.
Many patients with diabetes in sub-Saharan Africa are at increased risk of chronic complications and have extremely short life expectancies because of high rates of late diagnosis and a lack of access to affordable antidiabetic drugs, particularly insulin—a drug WHO has stated is essential for treating the disease. The authors call for glucose-lowering drugs and anti-hypertensive therapies to be funded in the same way as HIV/AIDS drugs along with "support for delivery mechanisms and chronic disease education and care models."
Diabetes is often poorly managed in routine health-care settings, being neglected in favour of communicable diseases. But there is growing evidence of the success of simple nurse-led diabetes primary-care systems in rural Africa, and the authors suggest that a well-funded community-based system could make cost-effective use of scarce resources. However, educators, specialists, and multidisciplinary support teams are urgently required to meet the needs of diabetes patients, especially in rural communities.
According to the authors, the health sector alone cannot bring about the vital population-wide lifestyle changes that are needed for diabetes control and care: "Prevention of obesity and type 2 diabetes will necessitate coordinated policy and legislative changes, with substantial attention given to the urban environment, transport infrastructure, and workplace opportunities for education and exercise."
They also point out that the shortage of data on epidemiology, chronic complications, diet, and the role of insulin means that research will be key to clarifying the causes, prevention, and control of diabetes in Africa.
They conclude by calling for: "A multidisciplinary, politically driven, and coordinated approach in areas of health, finance, education, sports, and agriculture can contribute to a reversal of the underlying causes of this epidemic, and a concerted multisectoral effort is vital to ensure improvement in diabetes health-care delivery."
Professor Jean Claude Mbanya, University of Yaoundé, Cameroon, Africa. (Please note that Professor Mbanya is at the American Diabetes Association meeting in Florida, USA). T) +32 496 124 987 (mobile) E) jcmbanya@yahoo.co.uk
For full Seminar, see: http://press.thelancet.com/adaafrica.pdf
Journal
The Lancet